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Universal Healthcare: How Do We Get There from Here?

Healthcare should be a right for all Americans. The best way for this to happen will be when we finally provide universal healthcare. Most Americans agree with this. Our problem has always been having the political will to enact it. It’s been a long, winding road.

In remarks to Congress, Harry Truman said, “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.” This was 1945. There had been prior attempts as far back as the 19th century, but none had ever succeeded. Indeed Truman did not succeed. But, he did plant the seed to the next phase of healthcare provision in this country.

The first successful national legislation came in 1965 when Lyndon Johnson signed Medicare and Medicaid into law under the appreciative gaze of Harry and Bess Truman. These programs changed the health trajectory of millions of Americans. Since that time, countless lives have been saved because more people have access to medical care.

But as we know all too well, the journey to a fully implemented national healthcare system has had many stops and starts. The closest we have come is when, in 2010, Barack Obama signed the Affordable Care Act into law, which has allowed millions of people who were either priced out of the market or had pre-existing conditions, to finally get affordable insurance. The poor have greatly benefited from the program as have the sickest persons. Unfortunately, everyone has not.

Many insurance companies have withdrawn from the program based on the uncertainties of funding. They have deemed the risk too high. Some insureds have faced rising premiums due to insurance companies pulling out of counties, even out of entire states. In some places, there is only one option on the exchanges. Much of this can be attributed to a miscalculation of how many young, healthy people would sign up instead of paying the tax penalty and also because all states did not accept the Medicaid expansion. Obamacare opponents in Congress and in state legislatures have hamstrung the program, setting it up for failure.

The Republicans have made a cottage industry out of repealing and replacing Obamacare. The major problem is, they had eight years to come up with a viable alternative and they didn’t. Since the Trump Administration took office they’ve learned the hard way that it is far easier to campaign against something than it is to repeal and replace something. People don’t take kindly to having benefits taken away after they have come to depend on them. If you don’t believe me, ask those Republican legislators who braved town halls. Ask the switchboard operators and congressional staff who have had to field thousands of phone calls, emails and faxes from extremely angry constituents demanding that they keep their hands of their healthcare.

Americans have found themselves pulled in two directions. On the one hand, the Republicans offer a stingy plan that would return pre-existing condition restrictions and allow insurance companies to sell bare-bones insurance plans to healthy persons which would be insurance on paper only. Meanwhile, the sickest people would be shunted into “high-risk pools” where they would receive coverage but at exorbitant prices. By the CBO estimate, at least 22,000,000 people would be without insurance over the next ten years.

On the other hand, you have progressives offering universal and single-payer proposals. Senator Bernie Sanders just rolled out his much-anticipated plan for Medicare for All. Senator Sanders ran on a platform that was built on a foundation of universal healthcare and now he has put some flesh on the bones. His proposal calls for a four-year rollout for full implementation. The proposal has the backing of at least 20 other Democratic senators.

Universal healthcare must happen in this country. Healthcare is not a privilege. It is a human right. We are at a crossroads where the cost of medical treatment and drugs is completely out of control. Doctors and drug companies control the prices and government programs already in place are not allowed to negotiate pricing with pharmaceutical companies. The major problem that must be addressed is the rising cost of insurance and care. Unless we can come to a place where all Americans have healthcare that won’t bankrupt them, we will continue to see a downward spiral in the health of this nation. We will see the buying power of consumers further decrease. Universal healthcare is a key to prosperity.

But there is the immediate problem of what to do with the hundreds of thousands of people who would lose jobs were the insurance industry to become obsolete and unnecessary. It is estimated that there are over 600,000 persons employed in the health insurance industry according to ThinkProgress. Also, because hospitals and medical practices have built their billing around the high costs they have been able to charge, there is a fear that there would be hospital closures and massive layoffs associated with the government’s ability to negotiate and regulate medical and drug costs.

I believe healthcare is a right for all Americans. But, I also believe we must be careful how we implement any new government single payer options. We need to make universal coverage our goal, but we have to implement steps toward it that will not harm our economy and cause massive job loss.

I believe we should first, shore up the ACA. A good place to start would be to ensure that subsidies for low-income persons will continue. Unless these subsidies continue, up to 7 million people could be priced out of the market. I would increase the subsidy amounts so that people who make up to 60,000 a year may receive the cost-sharing subsidy.

Second, the individual mandate must be continued and strengthened so that insurance providers can offset the cost of paying for their sicker consumers. I would continue the current tax penalty, but increase the amount they will have to pay should they choose not to purchase insurance. I would also withhold any refund that would be available until proof of insurance is provided. Just as you cannot drive your car without insurance, you shouldn’t be able to go without penalty if you don’t have health insurance.

Once the markets are stabilized, I believe we must restore the public option that was in the original version of the Affordable Care Act. This was removed at the insistence of the Republicans as well as former Democrat turned Independent Joe Lieberman. Several proposals have been put forward on how to do this. Senator Chris Murphy proposes that we allow people to buy into Medicare. This differs from Senator Sanders’ plan because his Medicare for All does not have premiums. You don’t buy in, you are automatically in. Most recipients of Medicare are satisfied with their coverage and enjoy benefits at a lower cost with low deductibles. The thinking is that when enough people are enrolled in Medicare, the private insurance market will gradually diminish and this will pave the way for single-payer, universal coverage.

We must maintain acceptable levels of benefits, including women’s health concerns. While abortion remains controversial, I would seek to put in place adequate funding for contraceptive services which includes safe, legal abortion. We must not continue making women’s lives and the choices they make to control their own bodies a secondary concern when it comes to healthcare. Women deserve to be able to access the full range of services they require to have healthy, happy lives.

While private insurance will decrease, there would still be opportunities for business by selling supplements. Coverage for things like cosmetic surgery or other elective procedures not considered medically necessary should be augmented on the private market and not at the expense of the taxpayers. Many Americans already purchase Medicare supplements to offset costs Medicare doesn’t cover. There will still be a need for these.

Once people have moved to this single payer option, then we move toward free Medicare for all.

Of course, it must be funded. John Conyers, Democrat from Michigan has put forth a bill, H.R. 676, which proposes funding from an array of sources.

The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill

Yes, there will be tax increases but they would be distributed based on income level. This would be taken out of your paycheck. Where you see deductions for Social Security and FICA, you would add a deduction for healthcare. The cost would be modest compared to the current premiums paid for health insurance. Also, the government already has billions of dollars dedicated to healthcare in the budget. Naturally, this would roll over into any new plan. One suggested addition to any legislation passed has been to add a line item to paychecks now that require your employers to show what they’re contributing to your healthcare premiums so when changes are made to the system, it will be harder for employers to keep the premium savings without compensation changes to the worker.

There are various ideas concerning a time table for moving to universal coverage. The Conyers bill sets a deadline of two years, while the Sanders proposal is four years. I recognize the longer we delay in implementing universal coverage, the more lives hang in the balance.

But the healthcare system in this country is both complex and cumbersome. There are trade offs to any change. I believe there needs to be adequate time allotted for the markets to adjust and absorb the new way of providing healthcare for Americans. I tend to believe it will take longer than four years for a complete transition and I believe adequate time should be given. If we fail to get this right, we will end up breaking both the healthcare industry and the economy in the process.

The time has come to move from conversation to action. I believe the American people deserve it. We must do our best to see to it that a parent no longer has to worry about cost when trying to take care of their sick child. The time has come where it doesn’t bankrupt a person when they have to care for an elderly parent. The time has come. The question is, will we have the will to do this? As your Congressman, I will work hard every day to make it so.